Antibiotic prophylaxis reduces UTI risk in children with VUR but increases antibiotic resistance

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Journal of pediatric urology Published June 5, 2026 Medically reviewed June 5, 2026 Study authors: Jhaveri Hasan, Stewart Aaron, Aitelli Audrey, Kaplan Samantha, Routh Jonathan C PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider the trade-off between UTI reduction and increased antibiotic resistance when prescribing CAP for VUR in children.

This systematic review and meta-analysis of randomized clinical trials evaluated continuous antibiotic prophylaxis (CAP) versus placebo, observation, or probiotics in 2577 patients aged 18 years or younger with vesicoureteral reflux (VUR). The primary outcome was risk of urinary tract infection (UTI). CAP significantly reduced UTI risk (pooled OR 0.79, 95% CI 0.65-0.94, p = 0.01). In studies with lower risk of bias, the protective effect was stronger (OR 0.54, 95% CI 0.41-0.71). However, CAP was associated with a substantially increased risk of antibiotic resistance (pooled OR 6.96, 95% CI 4.35-11.02). There was no difference between groups in new renal scarring (OR 1.06, 95% CI 0.78-1.45). The authors noted several limitations: risk of bias in many included studies, heterogeneity of methods across papers, and substantial statistical heterogeneity (I² = 58.12%). These findings suggest that while CAP reduces UTI risk, the trade-off of increased antibiotic resistance must be considered. Clinicians should weigh benefits and harms when deciding on prophylaxis in children with VUR.

Study Details

Study typeMeta analysis

Sample sizen = 2,577

EvidenceLevel 1

Follow-up216.0 mo

PublishedJun 2026

PMID41785522

View Original Abstract ↓

BACKGROUND: Controversy persists regarding continuous antibiotic prophylaxis (CAP) for vesicoureteral reflux (VUR) management. We sought to determine whether recent updates to the published literature continue to support the use of CAP in children with VUR. METHODS: We searched MEDLINE, EMBASE, Google Scholar, and Web of Science Core Collection electronic databases for all trials published of this topic. The study protocol was prospectively registered at PROSPERO (No. CRD42024587765). We included randomized controlled trials (RCTs) with patients 18 years or younger with VUR. Exclusion criteria included studies without reported number of patients treated or number who successfully completed treatment, conference abstracts, and non-English papers. Reports were assessed and data abstracted by two independent reviewers, with differences resolved by consensus. Risk of bias was assessed using standardized instruments. RESULTS: We identified 2603 studies, of which 13 were included in the meta-analysis with 2577 patients total. Pooled results demonstrated that CAP did significantly reduce the risk of UTI (pooled OR 0.79, 95 % CI 0.65-0.94, p = 0.01). In cases of UTI, there was an increased risk of antibiotic resistance in the CAP group (pooled OR 6.96, 95 % CI 4.35-11.02). There was no difference in the rates of new renal scarring between groups (pooled OR 1.06, 95 % CI 0.78-1.45). Substantial heterogeneity existed between studies with I 58.12 %. A subgroup analysis, stratified by each study's susceptibility to bias, demonstrated that studies at lower risk of bias had a stronger protective effect from CAP (pooled OR: 0.54, 95 % CI 0.41-0.71). DISCUSSION: Compared to placebo, observation, or probiotics, CAP significantly reduced the risk of recurrent UTIs; increased the risk of antibiotic resistance; but did not affect rates of new renal scarring. Limitations include risk of bias identified in many studies per Cochrane review and heterogeneity of methods across papers.